Organization
D&G PROVIDENCE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS GASORE KABUNDA (MANAGER)
(480) 285-5907
Entity
Organization
Contact information
Practice address
9186 W JOHN CABOT RD, PEORIA, AZ 85382-7716
(480) 285-5907
Mailing address
9186 W JOHN CABOT RD, PEORIA, AZ 85382-7716
(480) 285-5907
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
11/10/2022
Last updated
11/10/2022
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